Among patients with rheumatoid arthritis (RA), discordant treatment goals were found among 1 in 5 patient-clinician dyads, according to study data published in Arthritis Care & Research

Researchers enrolled adult patients with RA who were seen at least once in the prior 12 months at 1 of 2 rheumatology clinics. Before the routine visit, both patients and their clinicians independently ranked their top 3 goals from a list of 8 options. Patients completed postvisit surveys on health, demographics, health literacy, and adherence.

The definition of goal concordance was the patient’s top goal being among the clinician’s top 3 goals for that patient.


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Correlates of concordance were also explored using bi- and multivariable logistic regression models.

Overall, 204 patient-clinician dyads were included in the current analysis. Patients were mostly women (58%), with an average age of 57.2±14.2 years; median disease duration was 8 years and 29% had limited health literacy.

Goal concordance was achieved in 164 patient-clinician dyads (80%) and the agreement was largely driven by 124 dyads being concordant on the goal of “have less pain,” followed by “have fewer problems doing daily activities,” with 32 dyads (61.8%) being concordant on this goal. The goals of “improve sleep,” feel less tired,” and “improve mood” were selected more often by patients than clinicians, whereas clinicians prioritized “avoiding side effects of treatment.”

Disease duration was shorter in goal concordant vs discordant dyads (median, 7 vs 13.3 years; P =.039). Higher depressive symptoms were also associated with concordance (8.1% vs 24%, respectively; P =.04). Goal concordance was associated with higher medication adherence (adjusted odds ratio, 2.76, 95% CI, 1.01-7.56).

Study limitations included the inability to determine causality due to the cross-sectional study design, limited generalizability, inability to identify independent associations of limited English language proficiency and goal concordance, omission of 3 items from the Trust in Physician scale in the survey, lack of data on the duration of the patient-clinician relationships, and that the broad definition of concordance may have underestimated discordance.

Researchers concluded, “Systematic approaches to communication around goals and shared decision making may create an environment where sharing goals is normalized and working together to achieve them through both pharmacologic and non-pharmacologic means becomes standard of care.”

Reference

Barton JL, Markwardt S, Niederhausen M, et al. Are we on the same page?: A cross-sectional study of patient-clinician goal concordance in rheumatoid arthritis. Arthritis Care Res. Published online September 27, 2021. doi:10.1002/acr.24794